Turkish Archives of Otorhinolaryngology
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Türk Otorinolarengoloji Arşivi
Turk Arch Otorhinolaryngol 2018; 56(3): 133-8
Effect of Continuous Positive Airway Pressure on Overactive Bladder Symptoms in Patients with Obstructive Sleep Apnea Syndrome Tıkayıcı Uyku Apne Sendromlu Hastalarda Sürekli Pozitif Havayolu Basınç Tedavisinin Aşırı Aktif Mesane Semptomları Üzerine Etkisi Mehmet Emre Dinç1
, Mehmet Özgür Avinçsal2
, Mustafa Bahadır Can Balcı3
, Cengiz Özdemir4
Department of Otolaryngology - Head and Neck Surgery, Okmeydanı Training and Research Hospital, İstanbul, Turkey Department of Otolaryngology - Head and Neck Surgery, İstanbul Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey 3 Department of Urology, İstanbul Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey 4 Sleep Disorders Clinic, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey 1 2
Original Investigation Özgün Araştırma Abstract
Objective: To evaluate overactive bladder (OAB) in male and female patients with moderate or severe obstructive sleep apnea syndrome (OSAS) and to investigate the impact of three months of continuous positive airway pressure (CPAP) therapy on the symptoms of OAB. Methods: Twenty-eight female and 45 male patients with moderate and severe OSAS whose obstructive sleep apnea (OSA) severity was evaluated according to the apnea–hypopnea index were included in the study. Patients’ voiding symptoms were evaluated using the validated Turkish translations of overactive bladder symptom scores (OAB-V8) and the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) at OSAS diagnosis and at 3-months after the CPAP therapy.
Results: Patients with moderate and severe OSAS were more likely to have OAB than the average population, and CPAP therapy improved the symptoms of OAB in both male and female patients. In addition, a positive association was observed between OSA severity and OAB-V8 and ICIQ-SF in female patients and between OSA severity and OAB-V8 in male patients. Conclusions: Our findings suggest that CPAP therapy improves the clinical symptoms of OAB. Thus, unnecessary medical or interventional treatment of OAB can be avoided in such patients. Keywords: Obstructive sleep apnea syndrome, overactive bladder, continuous positive airway pressure, treatment
Öz
Amaç: Orta ve ağır tıkayıcı uyku apne sendromu (TUAS) olan erkek ve kadın hastalarda aşırı aktif mesaneyi (AAM) değerlendirmek ve üç ay boyunca devam eden sürekli pozitif havayolu basınç (SPHB) tedavisinin AAM semptomları üzerine etkisini araştırmak. Yöntemler: Bu çalışmaya tıkayıcı uyku apne (TUA) düzeyi apne-hipopne indeksi ile değerlendirilen, orta ve ağır TUAS’ı olan 28 kadın ve 45 erkek hasta dahil edildi. Hastaların işeme semptomları, TUAS tanısı aldıklarında ve üç aylık SPHB tedavisi aldıktan sonra, aşırı aktif mesane semptom skoru (AAM-V8) ve uluslararası inkontinansta konsültasyon kısa formunun (ICIQ-SF) onaylanmış Türkçe çevirileri kullanılarak değerlendirildi.
Bulgular: Toplum ortalaması ile karşılaştırıldığında orta ve ağır TUAS’lı hastalarda AAM’ye daha sık rastlandı ve SPHB tedavisi hem kadın hem de erkek hastalarda AAM semptomlarında düzelme sağladı. Buna ek olarak, kadın hastalarda TUA şiddeti ile OAB-V8 ve ICIQ-SF ve erkek hastalarda da OAB-V8 arasında pozitif bir ilişki olduğunu gözlemledik. Sonuç: Bulgularımız SPHB tedavisinin AAM klinik semptomlarında düzelme sağladığını göstermektedir. Bu nedenle, bu hastalarda AAM'ninı gereksiz tıbbi veya girişimsel tedavileri önlenebilir. Anahtar kelimeler: Tıkayıcı uyku apne sendromu, aşırı aktif mesane, sürekli pozitif havayolu basıncı, tedavi
ORCID IDs of the authors: M.E.D. 0000-0002-9931-8961; M.Ö.A. 0000-0002-3896-5807; M.B.C.B. 0000-0003-0395-1154; C.Ö. 0000-0002-9816-8885. Cite this article as: Dinç ME, Avinçsal MÖ, Balcı MBC, Özdemir C. Effect of Continuous Positive Airway Pressure on Overactive Bladder Symptoms in Patients with Obstructive Sleep Apnea Syndrome. Turk Arch Otorhinolaryngol 2018; 56(3): 133-8. Corresponding Author/Sorumlu Yazar: Mehmet Emre Dinç;
[email protected] Received Date/Geliş Tarihi: 23.01.2018 Accepted Date/Kabul Tarihi: 25.04.2018 © Copyright 2018 by Official Journal of the Turkish Society of Otorhinolaryngology and Head and Neck Surgery Available online at www.turkarchotolaryngol.net © Telif Hakkı 2018 Türk Kulak Burun Boğaz ve Baş Boyun Cerrahisi Derneği Makale metnine www.turkarchotolaryngol.net web sayfasından ulaşılabilir. DOI: 10.5152/tao.2018.3251
Introduction
Obstructive sleep apnea syndrome (OSAS) is a common sleep-related breathing disorder. Moderate to severe obstructive sleep apnea (OSA) affects 2%-14% of the general population (1). OSA is a repetitive episode of upper airway collapse occurring during sleep that leads to intermittent hypoxia, hypercapnia, increased respiratory effort, sleep
fragmentation, and increased sympathetic activity. It is commonly associated with cardiovascular and metabolic complications (2). Several studies have reported a relationship between OSA and urologic dysfunctions (3, 4). Earlier studies have also observed a positive association of OSAS with overactive bladder (OAB) as well as a correlation between the severity of OSAS and OAB in both men and women (3, 4).
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Dinç et al. OSAS and Overactive Bladder
Overactive bladder is defined as a urinary urgency with or without urge incontinence in the absence of a proven infection or an obvious pathology. Affected individuals often experience increased daytime frequency and nocturia. The key symptom is urinary urgency, which is a sudden irresistible desire to void that is difficult to delay. Despite extensive study, the etiopathogenesis of OAB remains unclear. The diagnosis of OAB requires the assessment of patient’s clinical symptoms while excluding other conditions (5). OAB has a considerable influence on the quality of life (QoL) of patients. Patients with OAB limit their physical activity and participation in social events, which leads to anxiety and depression. OAB can also cause urinary tract infections, which increases the number of healthcare visits. Treatment options range from lifestyle modifications to interventional therapy; however, the outcomes remain unsatisfactory. The efficacy of medical therapy is limited by potential side effects and poor responses. Despite several alternative treatment options being available, the outcomes remain poor (6). Continuous positive airway pressure (CPAP) therapy remains the standard treatment for confirmed cases of OSA (7). Although studies have shown an association between OSA and OAB in both men and women, the impact of CPAP therapy on the symptoms of OAB remains unclear. In this study, we evaluated OAB in male and female patients with moderate or severe OSA and evaluated the impact of three months of CPAP therapy on the symptoms of OAB.
Methods
Turk Arch Otorhinolaryngol 2018; 56(3): 133-8
under the guidance of a sleep physician. Sleep levels and the apnea–hypopnea index (AHI) were determined according to the recommendations of the American Academy of Sleep Medicine Task Force (8). Apnea was confirmed if at least a 90% cessation of airflow from baseline, continuing for a minimum of 10 s, was observed, and hypopnea was confirmed if at least a 30% reduction in the airflow, continuing for a minimum of 10 s, was observed and associated with an at least 4% reduction in arterial oxyhemoglobin saturation. Apneas were identified as obstructive if respiratory efforts were present and as central if respiratory efforts were absent. AHI was defined as the sum of the number of apneas and hypopneas per hour of sleep time, and the severity of OSA was defined using the following AHI cutoffs: simple snoring, AHI 0.05] between patients with moderate and severe OSA before CPAP therapy. When pre- and post-therapy parameters were compared to evaluate the effects of CPAP therapy, significant differences in OAB-V8 were noted between patients with moderate and severe OSA. The median OAB-V8 was significantly lower in patients with moderate [15 (1016.5) vs. 9 (711.5), p=0.035] and severe [16 (1221.5) vs. 10.5 (712.5), p
